S1302 Follow-Up Outcomes in Celiac Disease Patients Followed at a Large, Community-Based Gastroenterology Practice

Abstract

INTRODUCTION: Celiac disease (CD) is a chronic illness caused by an immune response to gluten and diagnosed with anti-tissue transglutaminase antibody testing and duodenal biopsies. Treatment is adherence to a gluten-free diet (GFD) which requires effective patient education, motivation, and frequent follow-up visits. Guidelines from prior studies in large academic settings recommend dietician referrals at time of diagnosis and periodic testing for micronutrient deficiencies. However, there is limited data to guide practice parameters in a community-based practice. The purpose of this study was to evaluate guideline adherence by community-based gastroenterologists. METHODS: We assessed CD care based on follow-up rates, micronutrient testing, symptoms and serology results in cohorts with and without dietician referrals. This retrospective study analyzed patients at Rockford Gastroenterology Associates (RGA), in Rockford, IL: a large private practice of 14 gastroenterologists and 7 nurse practitioners. Patients were included if they had a diagnosis from January 1, 2014 through December 31, 2018, based on positive serology and/or biopsy. Patient data was collected by chart review and analyzed through Microsoft Excel and SPSS. RESULTS: A cohort of 126 patients (84 female) met inclusion criteria. 69.8% had a dietician referral order. 65.9% had at least one lab test order for any of the 6 micronutrients (Table 1). Of the 80.2% that attended at least one follow-up appointment, 34.9% had only one and 19.8% had only two (Figure 1). A smaller cohort (79 patients), excluding those without follow-up symptom or serology data, was used for separating patients into 4 categories (Figure 2). Although patients with a referral had a higher proportion (32% vs 26%) in the asymptomatic and negative serology category, this was not statistically significant based on a fisher exact test value of 2.62 (P = .466). CONCLUSION: Dietician referral, micronutrient testing, and close follow-up are important parameters that affect outcomes in CD patients. The rates for dietician referral, some micronutrient testing and follow-up visits were higher than 50% in this study. Although a greater percentage of patients with a dietician referral were asymptomatic and had negative serology, this was not statistically significant. A larger, long-term study is needed to assess clinical outcomes in these patients and modify guidelines for the feasibility and practicality of multiple lab testing and follow-up care in community-based practice.Table 1.: Micronutrient orders and testing rates at follow-upFigure 1.: Time interval between time of diagnosis and follow-up visits.Figure 2.: Categorization of patients by symptoms and serology results.